scholarly journals Evolving Stroke in Tuberculous Meningitis

2021 ◽  
Author(s):  
Seng Wee Cheo ◽  
Rosdina Zamrud Ahmad Akbar ◽  
Song Weng Ryan Khoo ◽  
Yee Ann Tan ◽  
Qin Jian Low
Keyword(s):  
Tuberculous Meningitis ◽  
Neurological Complication ◽  
Severe Form ◽  
High Morbidity ◽  
Timely Initiation ◽  
Extra Pulmonary Tuberculosis ◽  
Aggressive Disease ◽  
Ct Brain ◽  
The Brain

Tuberculous meningitis (TBM) is the most severe form of extra-pulmonary tuberculosis which carries high mortality with 100% mortality without treatment. A neurological complication of TBM includes hydrocephalus, brain abscess and stroke. In this report, we would like to illustrate a case of stroke in a patient with TBM. In this case, a 37-year old man initially presented with fever for 1 week associated with severe headache and occasional vomiting. Computed tomography (CT) of the brain showed leptomeningeal enhancement and lumbar puncture findings consistent with infective in nature. His MARAIS score was 13 and was treated as tuberculous meningitis with anti-tuberculous therapy. While in the ward, he developed right-sided body weakness with evolving CT brain findings. His condition then stabilized with anti-tuberculous treatment which consists of isoniazid, rifampicin, pyrazinamide and streptomycin. Dexamethasone was also initiated. On follow up, his condition further improves and is functionally independent. In conclusion, tuberculous meningitis is an aggressive disease with high morbidity. Stroke can occur as a result of TBM. Timely initiation of treatment is important in improving the outcome of the patients.

scholarly journals OC 8277 IDENTIFICATION OF NEW CEREBROSPINAL FLUID AND BLOOD-BASED BIOMARKERS FOR THE DIAGNOSIS OF TUBERCULOUS MENINGITIS IN CHILDREN

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A3.2-A3
Author(s):  
Masilo Charles Manyelo ◽  
Regan S Solomons ◽  
Gerhard Walzl ◽  
Novel N Chegou
Keyword(s):  
Cerebrospinal Fluid ◽  
Tuberculous Meningitis ◽  
Point Of Care ◽  
Extrapulmonary Tuberculosis ◽  
Diagnostic Delay ◽  
Severe Form ◽  
High Morbidity ◽  
Serum Samples ◽  
Meningitis In Children ◽  
Study Participants

BackgroundTuberculous meningitis (TBM) is the most severe form of extrapulmonary tuberculosis (TB). It mostly affects young children and results in high morbidity and mortality, mainly due to diagnostic delay. There is an urgent need for new tests for the earlier and accurate diagnosis of the disease. We previously identified a 3-marker cerebrospinal fluid (CSF) biosignature (VEGF, IL-13, and LL-37) with potential to diagnose TBM. In the present study, we show that CSF and blood-based biosignatures may be useful in the diagnosis of TBM.MethodsCSF and serum samples were consecutively collected from 47 children that were admitted to the Tygerberg Academic Hospital in Cape Town, South Africa, on suspicion of having TBM. Using a multiplex platform, the concentrations of 69 host markers were evaluated in the CSF and serum samples from all the study participants, followed by statistical analysis to ascertain the usefulness of these biomarkers as diagnostic candidates for TBM disease.ResultsOut of the 47 study participants, 23 (48.9%) were finally diagnosed with TBM and 6 (12.8%) were infected with HIV. Several CSF and serum biomarkers showed potential individually as diagnostic candidates for TBM as ascertained by area under the receiver operator characteristics curve (AUC). However, the main findings of our study were the identification of a four-marker CSF biosignature which diagnosed TBM with an AUC of 0.97 (95% CI, 0.92–1.00), and a 3-marker serum biosignature which diagnosed TBM with an AUC of 0.84 (95% CI, 0.73–0.96). We also validated a previously identified 3-marker CSF biosignature (VEGF, IL13 and LL37) in the study.ConclusionCSF and serum biosignatures may be useful in the diagnosis of TBM in children. Our findings require further validation in larger, multi-site studies after which the biosignatures may be incorporated into point-of-care diagnostic tests for TBM.

scholarly journals Small epidural hematoma for surgery

2020 ◽  
Vol 22 (3) ◽  
pp. 57-59
Author(s):  
S. A. Elenany
Keyword(s):  
Conservative Treatment ◽  
Brain Edema ◽  
Glasgow Coma Score ◽  
Epidural Hematoma ◽  
Resonance Imaging ◽  
Surgical Case ◽  
Urgent Surgery ◽  
Ct Brain ◽  
The Brain

Introduction. Epidural hematoma (EDH) is when bleeding occurs between the tough outer membrane covering the brain (dura mater) and the skull. The most common cause is typically head injury. Diagnosis is typically by a computed tomography (CT) scan or magnetic resonance imaging. If large EDH, treatment is generally by urgent surgery in the form of a craniotomy or burr hole. Without treatment, death typically results. We explore a surgical case of small frontal EDH in patient with Glasgow Coma Score 8.Case report. Thirty years male patient was admitted at Emergency Hospital with Glasgow Coma Score 8 on ventilator. Rapid CT brain was done and showed massive brain edema with small EDH. Conservative treatment had been tried for 24 hours, but with no improvement as we could not give mannitol therapy to this patient. Follow-up CT showed the same EDH and brain edema. We tried new policy and evacuated EDH with giving mannitol and furosemide therapy postoperative. The patient became with Glasgow Coma Score 13 and improved in 7 days.Conclusion. Evacuation of small EDH may be helpful in some conditions not responding to conservative treatment especially in severe brain edema.

scholarly journals Potential of host serum protein biosignatures in the diagnosis of tuberculous meningitis in children

2019 ◽  
Author(s):  
Charles M Manyelo ◽  
Regan S Solomons ◽  
Candice I Snyders ◽  
Kim Stanley ◽  
Gerhard Walzl ◽  
...  
Keyword(s):  
Serum Protein ◽  
Tuberculous Meningitis ◽  
Diagnostic Delay ◽  
Final Diagnosis ◽  
Tertiary Hospital ◽  
Severe Form ◽  
Case Definition ◽  
High Morbidity ◽  
Serum Samples ◽  
Improved Performance

AbstractBackgroundTuberculous meningitis (TBM) is the most severe form of tuberculosis and results in high morbidity and mortality in children. Diagnostic delay contributes to the poor outcome. There is an urgent need for new tools for the rapid diagnosis of TBM, especially in children.MethodsWe collected serum samples from children in whom TBM was suspected at a tertiary hospital in Cape Town, South Africa. Children were subsequently classified as having TBM or no TBM using a published uniform research case-definition. Using a multiplex cytokine array platform, we investigated the concentrations of serum biomarkers comprising 7-markers that were previously found to be of value in the diagnosis of adult pulmonary TB (CRP, SAA, CFH, IFN-γ, IP-10, Apo-AI and transthyretin) plus other potentially useful host biomarkers as diagnostic candidates for TBM.FindingsOf 47 children included in the study, 23 (48.9%) had a final diagnosis of TBM of which six had HIV co-infection. A modified version of the adult 7-marker biosignature in which transthyretin was replaced by NCAM1, diagnosed TBM in children with AUC of 0.80 (95% CI, 0.67-0.92), sensitivity of 73.9% (95% CI, 51.6-89.8%) and specificity of 66.7% (95% CI, 44.7-84.4%). A new childhood TBM specific 3-marker biosignature (adipsin, Aβ42 and IL-10) showed potential in the diagnosis of TBM, with AUC of 0.84 (95% CI, 0.73-0.96), sensitivity of 82.6% (95 CI, 61.2-95.0%) and specificity of 75.0% (95% CI, 53.3-90.2%) after leave-one-out cross validation.ConclusionAn adult 7-marker serum protein biosignature showed potential in the diagnosis of TBM in children. However, a smaller childhood TBM-specific biosignature demonstrated improved performance characteristics. Our data indicates that blood-based biomarkers may be useful in the diagnosis of childhood TBM and require further investigation.

scholarly journals Tuberculous Meningitis: a case report of a late diagnosis

2013 ◽  
Vol 12 (1) ◽  
pp. 127
Author(s):  
Bruna Tassi Borille ◽  
Flávia Martinello ◽  
Andressa Verzeletti Rodrigues ◽  
Renata Gonçalves
Keyword(s):  
Tuberculous Meningitis ◽  
Late Onset ◽  
Delayed Diagnosis ◽  
Vascular Wall ◽  
Severe Form ◽  
Late Diagnosis ◽  
University Hospital ◽  
High Morbidity ◽  
Early Treatment Response ◽  
Previous Diagnosis

<div>Introduction: Tuberculous meningitis (TM) is the most severe form of tuberculosis, it has high morbidity and mortality. Once it is diagnosed early, treatment response is excellent. Objective: To report and discuss a case of delayed diagnosis of TM. Methodology: It was selected a case from University Hospital of Federal University of Santa Catarina, the analysis of medical records was performed and discussed based on the scientific literature. Results: It was reported the case of a patient that was diagnosed with leukocytoclastic</div><div>vasculitis (LV) for six months and was admitted presenting granulomatous lung injury, weight loss, fever and dry cough for eigth months. The delay in the diagnosis of tuberculosis (TB) allowed an evolution to TM and the late onset of treatment impaired the patient’s prognosis. It was discussed the vasculitis as a first symptom of tuberculosis, which can occur by deposition of immune complexes</div><div>formed by antibodies against antigens of bacilli in the vascular wall. Conclusions: Previous diagnosis of LV deviated the focus of the case for their cause, and suggested other pathologic conditions, which contributed to delay in the diagnosis of TB. Despite the late diagnosis and treatment, the therapeutic approaches used for vasculitis, TB and TM followed the protocols described in the literature.</div>

scholarly journals Gliomatosis Cerebri: A Report of Three Cases with Literature Review

2015 ◽  
Vol 22 (4) ◽  
pp. 35-43
Author(s):  
Ali M. Hendi
Keyword(s):  
Literature Review ◽  
Poor Prognosis ◽  
Clinical Presentation ◽  
Gliomatosis Cerebri ◽  
Extensive Literature ◽  
Postmortem Diagnosis ◽  
Aggressive Disease ◽  
The Central Nervous System ◽  
The Brain

Gliomatosis cerebri is a rare glioma of poor prognosis due to its diff use infiltration of the central nervous system involving three or more lobes of the brain. It has non-specifi c symptoms such as epilepsy, cognitivedisorders, headache and change in personality. Three cases of gliomatosis cerebri are reported. Extensive literature review was done. This review includes defi nition, type, clinical presentation, diagnosis [radiological and pathological], deferential diagnosis, treatment, and prognosis. In conclusion gliomatosis cerebri was initially a postmortem diagnosis. Following the advancement of the MRI, it became a radiological diagnosis that induces diff use involvement of at least three contiguous lobes of the brain with relative preservationof its general anatomical confi guration. It is manifested clinically as a very aggressive disease with poor prognosis. Imaging plays an important role in initial diagnosis, biopsy planning and follow up.

scholarly journals Comparative evaluation of IS6110 and protein antigen b PCR in cerebrospinal fluid for rapid diagnosis of tuberculous meningitis in children

2020 ◽  
Vol 69 (7) ◽  
pp. 979-985
Author(s):  
Sikha Agarwal ◽  
Arushi Gahlot Saini ◽  
Sumeet Dhawan ◽  
Alka Khadwal ◽  
Kusum Sharma ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Tuberculous Meningitis ◽  
Severe Form ◽  
Rapid Diagnosis ◽  
Protein Antigen ◽  
High Morbidity ◽  
Antigen B ◽  
Significant Difference ◽  
Lowenstein Jensen ◽  
Meningitis In Children

Introduction. Childhood tuberculosis meningitis is a severe form of tuberculosis with high morbidity and mortality. The diagnosis is frequently missed and delayed due to lack of sensitive tests like acid-fast bacilli (AFB) smear and delayed results by culture. Aims. To compare the role of IS6110 and protein antigen b PCR in cerebrospinal fluid (CSF) for rapid diagnosis of tuberculous meningitis (TBM) in children. Methodology. Forty-five cases of TBM and 20 controls were enrolled in this prospective study. Results. The mean ages of cases and controls were 4.2±0.5 years and 4.5±0.7 years, respectively. In the TBM group, two-thirds of the children were <4 years of age, and 62 % were males. Sensitivities of AFB smear examination, Löwenstein–Jensen (LJ) medium and bactenecin (BACTEC) culture in cases were 4.4, 0 and 2.2%, respectively. The protein antigen b PCR was most sensitive as it was positive in 35 (77.8 %) of TBM patients; IS6110 PCR was positive in 27 (60 %) patients. Both PCR-based tests had higher positivity than conventional tests and BACTEC culture. No significant difference was seen between the PCR tests. Excellent agreement was observed between both PCR-based tests as they were concordant for 26 positive samples and 35 negative samples. Conclusion. Protein b PCR is a sensitive and rapid method for the diagnosis of TBM (sensitivity 77.8 %). Both PCRs were more sensitive than smear, LJ and BACTEC. The specificity of both PCR was 100 %.

CT OF THE BRAIN IN TUBERCULOUS MENINGITIS: A review of 289 patients

2000 ◽  
Vol 41 (1) ◽  
pp. 13-17
Author(s):  
M. Özateş ◽  
S. Kemalogˇlu ◽  
F. Gürkan ◽  
Özkan Ü. ◽  
Not Available Not Available ◽  
...  
Keyword(s):  
Tuberculous Meningitis ◽  
The Brain

Longitudinal Changes in Individual BrainAGE in Healthy Aging, Mild Cognitive Impairment, and Alzheimer’s Disease

GeroPsych ◽  
2012 ◽  
Vol 25 (4) ◽  
pp. 235-245 ◽  
Author(s):  
Katja Franke ◽  
Christian Gaser
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Healthy Aging ◽  
Brain Aging ◽  
Elderly Subjects ◽  
Additional Increase ◽  
Longitudinal Changes ◽  
Novel Method ◽  
The Brain

We recently proposed a novel method that aggregates the multidimensional aging pattern across the brain to a single value. This method proved to provide stable and reliable estimates of brain aging – even across different scanners. While investigating longitudinal changes in BrainAGE in about 400 elderly subjects, we discovered that patients with Alzheimer’s disease and subjects who had converted to AD within 3 years showed accelerated brain atrophy by +6 years at baseline. An additional increase in BrainAGE accumulated to a score of about +9 years during follow-up. Accelerated brain aging was related to prospective cognitive decline and disease severity. In conclusion, the BrainAGE framework indicates discrepancies in brain aging and could thus serve as an indicator for cognitive functioning in the future.

Comparison of Fluorine(18)-fluorodeoxyglucose and Gallium(68)-citrate PET/CT in patients with tuberculosis

2019 ◽  
Vol 58 (05) ◽  
pp. 371-378
Author(s):  
Alfred O. Ankrah ◽  
Ismaheel O. Lawal ◽  
Tebatso M.G. Boshomane ◽  
Hans C. Klein ◽  
Thomas Ebenhan ◽  
...  
Keyword(s):  
Tracer Uptake ◽  
Pet Ct ◽  
The Mean ◽  
18F Fdg ◽  
Definition Of ◽  
Gallium 68 ◽  
Attending Physician ◽  
Pet Scans ◽  
The Brain

Abstract 18F-FDG and 68Ga-citrate PET/CT have both been shown to be useful in the management of tuberculosis (TB). We compared the abnormal PET findings of 18F-FDG- and 68Ga-citrate-PET/CT in patients with TB. Methods Patients with TB on anti-TB therapy were included. Patients had a set of PET scans consisting of both 18F-FDG and 68Ga-citrate. Abnormal lesions were identified, and the two sets of scans were compared. The scan findings were correlated to the clinical data as provided by the attending physician. Results 46 PET/CT scans were performed in 18 patients, 11 (61 %) were female, and the mean age was 35.7 ± 13.5 years. Five patients also had both studies for follow-up reasons during the use of anti-TB therapy. Thirteen patients were co-infected with HIV. 18F-FDG detected more lesions than 68Ga-citrate (261 vs. 166, p < 0.0001). 68Ga-citrate showed a better definition of intracerebral lesions due to the absence of tracer uptake in the brain. The mean SUVmax was higher for 18F-FDG compared to 68Ga-citrate (5.73 vs. 3.01, p < 0.0001). We found a significant correlation between the SUVmax of lesions that were determined by both tracers (r = 0.4968, p < 0.0001). Conclusion Preliminary data shows 18F-FDG-PET detects more abnormal lesions in TB compared to 68Ga-citrate. However, 68Ga-citrate has better lesion definition in the brain and is therefore especially useful when intracranial TB is suspected.

Brain FDG PET for the Etiological Diagnosis of Clinically Uncertain Cognitive Impairment During Delirium in Remission

2020 ◽  
Vol 77 (4) ◽  
pp. 1609-1622
Author(s):  
Franziska Mathies ◽  
Catharina Lange ◽  
Anja Mäurer ◽  
Ivayla Apostolova ◽  
Susanne Klutmann ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Fdg Pet ◽  
False Negative ◽  
Ground Truth ◽  
Etiological Diagnosis ◽  
Geriatric Unit ◽  
Positron Emission ◽  
The Brain ◽  
Hospitalized Geriatric Patients

Background: Positron emission tomography (PET) of the brain with 2-[F-18]-fluoro-2-deoxy-D-glucose (FDG) is widely used for the etiological diagnosis of clinically uncertain cognitive impairment (CUCI). Acute full-blown delirium can cause reversible alterations of FDG uptake that mimic neurodegenerative disease. Objective: This study tested whether delirium in remission affects the performance of FDG PET for differentiation between neurodegenerative and non-neurodegenerative etiology of CUCI. Methods: The study included 88 patients (82.0±5.7 y) with newly detected CUCI during hospitalization in a geriatric unit. Twenty-seven (31%) of the patients were diagnosed with delirium during their current hospital stay, which, however, at time of enrollment was in remission so that delirium was not considered the primary cause of the CUCI. Cases were categorized as neurodegenerative or non-neurodegenerative etiology based on visual inspection of FDG PET. The diagnosis at clinical follow-up after ≥12 months served as ground truth to evaluate the diagnostic performance of FDG PET. Results: FDG PET was categorized as neurodegenerative in 51 (58%) of the patients. Follow-up after 16±3 months was obtained in 68 (77%) of the patients. The clinical follow-up diagnosis confirmed the FDG PET-based categorization in 60 patients (88%, 4 false negative and 4 false positive cases with respect to detection of neurodegeneration). The fraction of correct PET-based categorization did not differ between patients with delirium in remission and patients without delirium (86% versus 89%, p = 0.666). Conclusion: Brain FDG PET is useful for the etiological diagnosis of CUCI in hospitalized geriatric patients, as well as in patients with delirium in remission.

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